scholarly journals Craniosynostosis: Clinical Presentation and Outcome of Surgical Treatment

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
AURANGZEB KALHORO ◽  
A. SATTAR M. HASHIM
Keyword(s):  
Intracranial Pressure ◽  
Perioperative Management ◽  
Major Complication ◽  
Cranial Sutures ◽  
Raised Intracranial Pressure ◽  
Surgical Expertise ◽  
Metopic Suture ◽  
Age Range ◽  
Strip Craniectomy

Objective:  Craniosynostosis presents sclerosis cranial sutures, ossification and fusion involving the vault of the base, sutures involved can be one or more sutures. This study aimed to determine the surgical outcome of craniosynostosis. Material and Method:  The prospective study was conducted at the neuro spinal and cancer care institute, Karachi. Patients presented with sagittal, metopic, unicoronal, lambdoid, bicoronal craniosynostosis were included in the study, while patients with coagulopathy, previously operated cases were excluded from the study. Results:  We had 26 children in our study, age range about 1–3 years. Patients were cleaved into groups depending on their age. Most of the children 15 (57.6%) were in 1–2 years age group and 11 (42.3%) were in 2-3 years of age. Boys were 18 (69.2%) and girls were 8(30.7%). Coronal 11 (42.3%) was the most common suture involved, followed by sagittal 9 (34.6%). Lambdoid suture 3 (11.5%), metopic 2 (7.6%) and 3 (11.5%) case presented with raised intracranial pressure with multiple sutures closed involved. Strip craniectomy was done in all cases. We did bicoronal flap and Scalp flap turned into a supraorbital region while in metopic suture Fronto-orbital advancement and remodeling approach were used. No major complication was observed. Conclusion:  Cases which are managed early age have given good acceptable results in follow up, proper surgical expertise, perioperative management of temperature, blood loss, relieving the restriction of sutures and normalizing raised intracranial pressure can decrease the morbidity and mortality.

scholarly journals Treatment of Intracranial Aneurysms Using Flow-Diverting Silk Stents (BALT): A Single Centre Experience

2011 ◽  
Vol 17 (3) ◽  
pp. 306-315 ◽  
Author(s):  
M. Leonardi ◽  
L. Cirillo ◽  
F. Toni ◽  
M. Dall'Olio ◽  
C. Princiotta ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Major Complication ◽  
Mass Effect ◽  
Time Frame ◽  
Post Treatment ◽  
Parent Artery ◽  
Silk Stent ◽  
Single Centre Experience ◽  
Age Range

The Silk stent (Balt, Montmorency, France) is a retractable device designed to achieve curative reconstruction of the parent artery associated with an intracranial aneurysm. We present our initial experience with the Silk flow-diverting stent in the management and follow-up of 25 patients presenting with intracranial aneurysms. Twenty-five patients (age range, 34–81 years; 24 female) were treated with the Silk flow-diverting device. Aneurysms ranged in size from small (5), large (10) and giant (10) and included wide-necked aneurysms, multiple, nonsaccular, and recurrent intracranial aneurysms. Nine aneurysms were treated for headache, 14 for mass effect. None presented with haemorrhage. All patients were pretreated with dual antiplatelet medications for at least 72 hours before surgery and continued taking both agents for at least three months after treatment. A total of 25 Silk stents were used. Control MR angiography and/or CT angiography was typically performed prior to discharge and at one, three, six and 12 months post treatment. A follow-up digital subtraction angiogram was performed between six and 19 months post treatment. Complete angiographic occlusion or subtotal occlusion was achieved in 15 patients in a time frame from three days to 12 months. Three deaths and one major complication were encountered during the study period. Two patients, all with cavernous giant aneurysms, experienced transient exacerbations of preexisting cranial neuropathies and headache after the Silk treatment. Both were treated with corticosteroids, and symptoms resolved completely within a month. In our experience the Silk stent has proven to be a valuable tool in the endovascular treatment of intracranial giant partially thrombosed aneurysms and aneurysms of the internal carotid artery cavernous segment presenting with mass effect. The time of complete occlusion of the aneurysms and the risk of the bleeding is currently not predictable.

scholarly journals Neuroendoscopic treatment of idiopathic occlusion of unilateral foramen of Monro presenting as chronic headache

2016 ◽  
Vol 7 (01) ◽  
pp. 128-130 ◽  
Author(s):  
Dhaval Shukla
Keyword(s):  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Clinical Features ◽  
Chronic Headache ◽  
Primary Headache ◽  
Raised Intracranial Pressure ◽  
Foramen Of Monro ◽  
Clinical Dilemma

ABSTRACTAsymmetric ventriculomegly due to idiopathic occlusion of the foramen of Monro is rare. Such patients present with clinical features of raised intracranial pressure (ICP). Presentation as chronic headache has not been previously described. In the absence of raised ICP, pursuing surgical treatment raises a clinical dilemma as the headache may be a primary headache with no improvement after surgery. A 21-year-old woman presented with chronic headache. She was found to have asymmetric ventriculomegaly due to the occlusion of the foramen of Monro. She underwent endoscopic septostomy and widening of the foramen of Monro. Her headache subsided after surgery. At 15 months of follow-up, she was free from headache without medications. Unilateral occlusion of the foramen of Monro can present with asymmetric ventriculomegaly resulting in chronic headache. Though the symptoms of raised ICP may not be present, still endoscopic relief of ventriculomegaly leads to cure of headache.

Complications of Epilepsy Surgery after 654 Procedures in Sweden, September 1990–1995: A Multicenter Study Based on the Swedish National Epilepsy Surgery Register

Neurosurgery ◽  
2001 ◽  
Vol 49 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Bertil Rydenhag ◽  
Hans C:son Silander
Keyword(s):  
Epilepsy Surgery ◽  
Surgical Procedures ◽  
Multicenter Study ◽  
Daily Living ◽  
Major Complication ◽  
Strip Electrode ◽  
Therapeutic Procedures ◽  
Age Range ◽  
Inclusion Period

Abstract OBJECTIVE To present the first national multicenter study on complications after epilepsy surgery procedures to include all epilepsy surgery centers in Sweden: Göteborg, Linköping, Lund, Stockholm, Umeå, and Uppsala. METHODS Every epilepsy surgery procedure in Sweden is reported to the Swedish National Epilepsy Surgery Register. The report includes relevant social and medical items and complications. A complication is defined as minor if it resolves within 3 months and major if it affects activities of daily living and lasts longer than 3 months. Follow-up data are recorded for 2 years after the operation. Intrinsic checkpoints and external revision validate the register data. RESULTS During the inclusion period (September 1990–December 1995), 654 surgical procedures were performed (age range, 6 mo–67 yr). Of these, 205 were invasive electrode procedures (182 first investigations and 23 reinvestigations), and 449 were therapeutic procedures (375 first operations and 74 reoperations). After invasive electrode procedures, only minor complications were reported (6.3%). For all 449 therapeutic procedures (including reoperations), minor complications were reported in 8.9% and major complications in 3.1%. Only one major complication was reported in a patient under the age of 35 years. CONCLUSION This is the first national multicenter study on complications after epilepsy surgery. It demonstrates that these procedures as performed at six different centers in Sweden are safe, but also that risk is related to age. In patients younger than age 35 years, the risk for a major complication after invasive subdural strip electrode investigation and epilepsy surgery is low.

Results of early surgery for sagittal suture synostosis: long-term follow-up and the occurrence of raised intracranial pressure

2013 ◽  
Vol 29 (6) ◽  
pp. 997-1005 ◽  
Author(s):  
Marie-Lise C. van Veelen ◽  
Oscar H. J. Eelkman Rooda ◽  
Tim de Jong ◽  
Ruben Dammers ◽  
Leon N. A. van Adrichem ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Early Surgery ◽  
Raised Intracranial Pressure ◽  
Sagittal Suture ◽  
Long Term Follow Up

Decompressive Craniectomy and Cranioplasty: A Review of the Literature on Evolution, Indications, Surgical Techniques, and Complications

Neurographics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 12-25
Author(s):  
R. Sinha ◽  
R. Siripurapu ◽  
A. Herwadkar
Keyword(s):  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Surgical Techniques ◽  
Perioperative Period ◽  
Optimal Time ◽  
Acute Ischemia ◽  
Raised Intracranial Pressure ◽  
Imaging Evaluation ◽  
Skull Vault

Decompressive craniectomy refers to removal of a portion of the skull without subsequent replacement, and cranioplasty involves subsequent repair of the skull vault defect. Over the past 3 decades, there has been considerable interest in the use of decompressive craniectomy as part of a second-level measure in the management of refractory raised intracranial pressure. Raised intracranial pressure can be secondary to various causes, including severe head injury, subarachnoid hemorrhage, infection, and acute ischemia. Although the procedure is thought to be effective, several factors should be taken into consideration, including patient selection, optimal time for intervention, risk of associated complications, and patient outcomes. After a craniectomy, patients may subsequently undergo cranioplasty for various reasons, including cosmetic improvement, protection of brain tissue, and as treatment for syndrome of the trephined. Several different materials have been trialed over the years, including biologic and nonbiologic substitutions. Perioperative imaging evaluation plays an important role in the management and follow-up of these patients. The focus of this article is on the expected radiologic appearances in the perioperative period as well as the complications that may arise. Surgical techniques, cranioplasty materials, and historic evolution of decompressive craniectomy and cranioplasty will also be discussed.Learning Objective: To understand the rationale for decompressive craniectomy and cranioplasty as well as recognize the expected postoperative radiologic appearances and their associated complications.

A single-center experience with symptomatic postoperative calvarial growth restriction after extended strip craniectomy for sagittal craniosynostosis

2010 ◽  
Vol 5 (1) ◽  
pp. 131-135 ◽  
Author(s):  
Matthew A. Adamo ◽  
Ian F. Pollack
Keyword(s):  
Intracranial Pressure ◽  
Growth Restriction ◽  
Increased Intracranial Pressure ◽  
Sagittal Synostosis ◽  
Sagittal Craniosynostosis ◽  
Single Center Experience ◽  
Number Of Patients ◽  
Single Suture ◽  
Strip Craniectomy

Object Sagittal synostosis accounts for the most common form of craniosynostosis, occurring with an incidence of 1 in 2000–5000 live births. In most cases of single-suture, nonsyndromic sagittal synostosis, a single operation is all that is required to achieve a reasonable cosmetic result. However, there are a number of patients who may experience symptomatic postoperative calvarial growth restriction secondary to fibrosis of newly formed bone and pericranium that replace the surgically removed sagittal suture, or due to fusion of other previously open sutures leading to increased intracranial pressure, necessitating a second operation. Methods A retrospective review was conducted of all cases involving infants who had undergone an extended sagittal strip craniectomy with bilateral parietal wedge osteotomies at our institution between 1990 and 2006 for single-suture, nonsyndromic sagittal craniosynostosis. The frequency with which subsequent operations were required for cranial growth restriction was then defined. Results There were a total of 164 patients with single-suture nonsyndromic sagittal synostosis. Follow-up data were available for 143 of these patients. The average age at time of initial operation was 5.25 months, and the mean duration of follow-up was 43.85 months. There were 2 patients (1.5%) who required a second operation for symptomatic postoperative calvarial growth restriction. Conclusions Recurrence of synostosis with resultant increased intracranial pressure in cases of single-suture, nonsyndromic sagittal craniosynostosis is an uncommon event, but does occur sporadically and unpredictably. Therefore, we recommend routine neurosurgical follow up for at least 5 years, with regular ophthalmological examinations to assess for papilledema.

Papilledema in unicoronal synostosis: a rare finding

2019 ◽  
Vol 24 (2) ◽  
pp. 139-144
Author(s):  
Stephanie D. C. van de Beeten ◽  
Martijn J. Cornelissen ◽  
Renee M. van Seeters ◽  
Marie-Lise C. van Veelen ◽  
Sarah L. Versnel ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Intracranial Pressure ◽  
Growth Curve ◽  
Head Circumference ◽  
Raised Intracranial Pressure ◽  
Single Center ◽  
Rare Finding ◽  
Age At Surgery ◽  
Repeated Surgery

OBJECTIVEUnicoronal synostosis results in frontal plagiocephaly and is preferably treated before the patient is 1 year of age to prevent intracranial hypertension (ICH). However, data on the prevalence of ICH in these patients is currently lacking. This study aimed to establish the prevalence of preoperative and postoperative signs of ICH in a large cohort of patients with unicoronal synostosis and to test whether there is a correlation between papilledema and occipitofrontal head circumference (OFC) curve stagnation in unicoronal synostosis.METHODSThe authors included all patients with unicoronal synostosis treated before 2 years of age at a single center between 2003 and 2013. The presence of ICH was evaluated by routine fundoscopy. The OFC growth curve was analyzed for deflection and in relationship to signs of ICH.RESULTSIn total, 104 patients were included in this study, 84 (81%) of whom were considered to have nonsyndromic unicoronal synostosis. Preoperatively, none of the patients had papilledema as determined by fundoscopy (mean age at surgery 11 months). Postoperatively, 5% of patients with syndromic synostosis and 3% of those with nonsyndromic synostosis had papilledema, and this was confirmed by optical coherence tomography. Raised intracranial pressure was confirmed in 1 patient with syndromic unicoronal synostosis. Six of 78 patients had OFC stagnation, which was not significantly correlated to papilledema (p = 0.22). One child with syndromic unicoronal synostosis required repeated surgery for ICH (0.96%).CONCLUSIONSPapilledema was not found in patients with unicoronal synostosis when they underwent surgery before the age of 1 year and was also very rare during follow-up. There was no relationship between papilledema and OFC stagnation.

scholarly journals The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

2015 ◽  
Vol 15 (4) ◽  
pp. 350-360 ◽  
Author(s):  
Gregory P. L. Thomas ◽  
David Johnson ◽  
Jo C. Byren ◽  
Andrew D. Judge ◽  
Jayaratnam Jayamohan ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Surgical Procedure ◽  
Raised Intracranial Pressure ◽  
Sagittal Craniosynostosis ◽  
Primary Surgery ◽  
Age At Surgery ◽  
Long Term Follow Up ◽  
Procedure Type

OBJECT Raised intracranial pressure (ICP) is recognized to occur in patients with nonsyndromic isolated sagittal craniosynostosis (SC) prior to surgery. However, the incidence of raised ICP following primary surgery is rarely reported and there appears to be a widely held assumption that corrective surgery for SC prevents the later development of intracranial hypertension. This study reports the incidence of postoperative raised ICP in a large cohort of patients with SC treated by 1 of 2 surgical procedures in a single craniofacial unit. METHODS A retrospective review was performed of all patients with SC who underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure under the care of the Oxford Craniofacial Unit between 1995 and 2010 and who were followed up for more than 2 years. The influence of patient age at surgery, year of surgery, sex, procedure type, and the presence of raised ICP preoperatively were analyzed. RESULTS Two hundred seventeen children had primary surgery for SC and were followed up for a mean of 86 months. The overall rate of raised ICP following surgery was 6.9%, occurring at a mean of 51 months after the primary surgical procedure. Raised ICP was significantly more common in those patients treated by MSC (13 of 89 patients, 14.6%) than CR (2 of 128 patients, 1.6%). Also, raised ICP was more common in patients under 1 year of age, the majority of whom were treated by MCS. No other factor was found to have a significant effect. CONCLUSIONS Postoperative raised ICP was found in more than 1 in 20 children treated for nonsyndromic SC in this series. It was significantly influenced by the primary surgical procedure and age at primary surgery. Careful long-term follow-up is essential if children who develop raised ICP following surgery are not to be overlooked.

scholarly journals Single center experiences with telemetric intracranial pressure measurements in patients with CSF circulation disturbances

2020 ◽  
Vol 162 (10) ◽  
pp. 2487-2497
Author(s):  
Valentina Pennacchietti ◽  
Vincent Prinz ◽  
Andreas Schaumann ◽  
Tobias Finger ◽  
Matthias Schulz ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Signs And Symptoms ◽  
Outpatient Basis ◽  
Pressure Measurements ◽  
Implantation Time ◽  
Promising Tool ◽  
Shunt Implantation ◽  
Postoperative Seizure ◽  
Age Range

Abstract Background Hydrocephalus may present with heterogeneous signs and symptoms. The indication for its treatment and the optimal drainage in complex cases may be challenging. Telemetric intracranial pressure measurements (TICPM) may open new perspectives for those circumstances. We report our experiences using the Neurovent-P-tel and the Sensor Reservoir in a retrospective study. Methods A series of 21 patients (age range 10–39.5 years) treated in our Pediatric Neurosurgical Unit receiving a TICPM was analyzed. In 8 patients, a Neurovent-P-Tel was implanted; 13 patients received a Sensor Reservoir, 6 of which as a stand-alone implant, while 7 were already shunted. TICPM were performed on an outpatient basis. Possible complications, follow-up surgeries, and TICPM were analyzed. Results Concerning the complications, one infection was seen in each group and one postoperative seizure was observed in the P-tel group. TICPM-assisted shunt adjustments lead to clinical improvements in six patients in the P-tel group and six patients in the Sensor Reservoir group. In four out of six non-shunted patients, TICPM contributed to the indication toward shunt implantation. Conclusions TICPM seems to be a promising tool to improve clinical management of shunted patients with complex hydrocephalus. The two available systems will need further technical improvements, concerning implantation time, measurements, and data analysis in order to optimize handling and interpretation of the data.

Sign in / Sign up

Export Citation Format

Share Document